Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the app...Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.展开更多
BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective...BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.展开更多
目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者...目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者105例,男71例,女34例,年龄(55.20±10.98)岁,病程(15.91±9.85)个月。所有患者按日本骨坏死研究会(Japanese Investigation Committee,JIC)分型分为4组:A型17例,B型26例,C1型33例,C2型29例。所有患者行髓芯减压植骨术,术前及术后3、6、12、24个月随访时采用视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分,复查X线片观察2年内股骨头塌陷情况。结果:105例患者手术成功获得随访,时间(24.45±2.75)个月,无手术并发症发生。Harris评分在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间Harris评分比较差异有统计学意义(P<0.01)。VAS在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间的VAS比较差异有统计学意义(P<0.01)。4组患者在术前、术后3、6个月时均未发生股骨头塌陷;术后12个月C组发生股骨头塌陷3例,C2组发生4例(P>0.05);术后24个月B组发生股骨头塌陷1例、C1组发生6例、C2组发生8例(P<0.05)。结论:髓芯减压植骨术可提高股骨头坏死保髋疗效,而股骨头坏死保髋疗效与骨坏死病灶位置密切相关,临床治疗中应考虑到病灶位置对保髋疗效的影响,以更好的在术前制定保髋方案。展开更多
文摘Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.
基金Supported by The First Hospital of Qiqihar,No.2013-006Department of Veterans Affairs and the Veterans Administration Medical Center in Memphis,No.I01 BX000671.
文摘BACKGROUND Osteonecrosis of the femoral head(ONFH)is a destructive condition most commonly affecting young and middle-aged patients.The leading consequence of ONFH is often a significant articular disability.Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.AIM To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique,which is a new way of jointpreserving surgical treatments.METHODS The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed;the follow-up ended in December 2019.RESULTS There were 6 male patients with an average age of 43 years in our study.Gratifying results have been obtained from the comparison of Harris hip score,visual analogue scale,and imaging examination before and after operation.CONCLUSION This new modified technique is simple,safe,and reliable.No serious perioperative complications were observed in our cases.Advantages of the single blade expandable reamer are obvious.The adjuvant substance is inexpensive and easy to obtain.Thus,this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.
文摘目的:分析髓芯减压植骨保髋手术对不同坏死病灶位置早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。方法:回顾分析2017年1月至2018年12月骨循环协会(Association Research Circulation Osseous,ARCO)Ⅱ期ONFH患者105例,男71例,女34例,年龄(55.20±10.98)岁,病程(15.91±9.85)个月。所有患者按日本骨坏死研究会(Japanese Investigation Committee,JIC)分型分为4组:A型17例,B型26例,C1型33例,C2型29例。所有患者行髓芯减压植骨术,术前及术后3、6、12、24个月随访时采用视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分,复查X线片观察2年内股骨头塌陷情况。结果:105例患者手术成功获得随访,时间(24.45±2.75)个月,无手术并发症发生。Harris评分在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间Harris评分比较差异有统计学意义(P<0.01)。VAS在术前及术后3、6个月时各组间比较差异均无统计学意义(P>0.05),在术后12、24个月时各组间比较差异有统计学意义(P<0.01),各组术前及术后各时间点间的VAS比较差异有统计学意义(P<0.01)。4组患者在术前、术后3、6个月时均未发生股骨头塌陷;术后12个月C组发生股骨头塌陷3例,C2组发生4例(P>0.05);术后24个月B组发生股骨头塌陷1例、C1组发生6例、C2组发生8例(P<0.05)。结论:髓芯减压植骨术可提高股骨头坏死保髋疗效,而股骨头坏死保髋疗效与骨坏死病灶位置密切相关,临床治疗中应考虑到病灶位置对保髋疗效的影响,以更好的在术前制定保髋方案。
